Obsessive-compulsives follow psychologist on trek to confront their fears

Eleven-year-old Christian Low was first in line for the bathroom exercise.

Following a protocol demonstrated moments earlier, the Colorado youth pressed his bare hands against the rim of a urinal, licked each palm, then reached out to accept a Tic Tac. Before popping the mint into his mouth, Christian added a move of his own: He dropped it onto the tile floor and stomped on it. The ad lib elicited gasps, congratulatory pats on the back, and applause from onlookers crammed into the men's room on a lower level of the Hyatt Regency Crystal City.

As the others took their turn at the bizarre ritual, Christian leaned on a wall outside, seeming pleased if perhaps a bit queasy. "I wanted to challenge myself," he said. Christian later told his father, Kern Low, that he would no longer struggle with paralyzing fears of contamination associated with public restrooms, a problem that had interfered with family outings for the past three years.

Facing fears was the evening's objective for Christian and about 150 other people dealing with obsessive-compulsive disorder (OCD). Led by psychologist Jonathan Grayson, they were going "Virtual Camping" -- a two-hour after-dark excursion and germfest that was part of the 2010 International OCD Foundation Conference held at the Hyatt Regency last month.

"What can you do in one night?" Grayson had asked as the evening began. "You can take a step toward learning how to deal with uncertainty." Then he led the participants into the steamy streets of Crystal City, where, among other things, they would be encouraged to shake the hand of a homeless man (to fight more contamination fears), to chant "Crash and burn" to passing motorists (to show that thoughts would not cause actual harm) and to touch ripe garbage with their bare hands (contamination, again).

OCD, which affects approximately 2.2 million American adults, is characterized by recurrent unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Desires for certainty and perfection are also hallmarks of the disorder, said Grayson, director of the Anxiety and OCD Treatment Center of Philadelphia.

Screaming and moaning

Grayson, 58, has been offering "Virtual Camping" at the OCD conference for 10 years, after taking patients on actual camping expeditions and watching them successfully confront their fears of dirt, lack of control and unpredictable situations.

He doesn't consider the virtual version a substitute for therapy. "It's a convention demonstration," he said. "But it can inspire people to go to treatment. And there are people who have made real gains here."

Wearing an Indiana Jones-style hat, Grayson herded the group from spot to spot, making jokes, issuing challenges and rallying the nervous and the timid. Standing below a street lamp in an empty parking lot, he asked: "Is anyone afraid they'll hurt someone?" About 10 people stepped forward. Grayson issued each of them a paring knife and told them to walk through a gantlet formed by the other members of the group. "Your job is to hold the knife in front of you," he said, "and we'll see if you kill anyone."

The participants started out tentatively, limply wielding their weapons, until Grayson commanded, "Hold it like you mean it!" To heighten the sense of drama, he directed the people in the gantlet to scream and moan as though they were being stabbed.

Hilary Zurbuch emerged with one hand trembling around a knife handle and the other covering her eyes. "That was pretty anxiety-provoking," said the 30-year-old Pittsburgh resident, whose disorder, diagnosed when she was 19, has become so severe that she has been unable to perform her job as a psychotherapist.

Later, Grayson ordered a group hug -- a germ-spreading exercise made even grimier and sweatier by the 95-degree urban heat.

First he asked everyone to turn in their hand sanitizers so they would not be tempted to disinfect themselves afterward. Instead, they'd have to fully experience their contamination anxiety and wait until it dissipated naturally, an important step in the therapy known as exposure and response prevention, or ERP.

"That wasn't just Purell," Zurbuch groused, after coughing up her sanitizer. "It was Bath & Body Works. It was the good stuff." She shrugged. "It's gone." But a moment later, she grinned and confided, "I have another bottle back in my room."

'I couldn't do it'

Contamination was a big deal for Mariann Kruer, too. The wisp-like woman from Floyds Knobs, Ind., refused to touch a cigarette-butt-chewing-gum combo that Grayson had lifted from the grimy rim of a sidewalk trash receptacle and passed around.

"I couldn't do it," said Kruer, 33, who also avoided gripping the handrail of the hotel escalator as the group made its way to the restrooms and the evening's grand finale. "My mind was running through where the gum had been."

But Kruer, who like many OCD sufferers attends therapy and takes medication, somehow summoned the courage to participate in the toilet/Tic Tac ritual. Afterward, though, she sobbed in the arms of her husband, Phil, who stood outside the restroom.

Noticing Kruer's distress, Grayson approached her after dismissing the rest of the group. He asked about her dreams for the future, then told her that OCD was interfering with these goals. "You're putting your fears in front of everything you want in life," he said.

Kruer nodded and confessed that, since September, she'd considered her husband to be contaminated and, as a result, the two have been unable to attempt to conceive a child, despite their strong desire to start a family.

"But it's gross," she said of the toilet she'd just touched.

"It is gross," agreed Grayson, who had taken part in that exercise himself. "You might even get sick, although you're actually more likely to die in a car crash."

The two kept talking, and something apparently persuaded Kruer to continue. The next morning, she attended a workshop in which both she and her husband ate breath mints off the floor and chewed "ABC" gum, Grayson's term for "Already Been Chewed." (When people are disturbed by that last image -- and who wouldn't be? -- Grayson tells them to consider the people they've French-kissed. He insists there's no difference.) Going to such extremes, Grayson explained, is a way to make them confront their disorder rather than run from it or engage in useless rituals.

By lunch, Kruer seemed like a different person: emboldened, hopeful and more connected to her husband, who she now believed understood her disorder.

"I was just sort of here at the conference, taking it all in, until Friday night and the Virtual Camping," Kruer said. "Now I feel like I want to move forward. I want to reconnect with my husband and my friends and everyone that I couldn't fit into my old routines and my housebound life.